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Acta gastro-enterologica Belgica 03/2013; 76(1):66-7. · 0.64 Impact Factor
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ABSTRACT: BACKGROUND: This retrospective study compared the fast-track colon surgery program to conventional perioperative care and assessed factors that influence postoperative length of stay. DESIGN: This retrospective study included 124 fast-track and 119 conventional care colon surgical patients. Exclusion criteria were primary rectal disease, stoma, American Society of Anesthesiologists score IV, and Association Française de Chirurgie index 3 or 4. Laparoscopy was the preferred approach. Variables influencing length of stay were analyzed by multivariate linear and logistic regression. RESULTS: Overall mortality and complication rates were not significantly different between groups (fast-track vs. controls 0 vs. 0.8 %, 30.6 vs. 38.6 % respectively). As expected, median length of stay was significantly reduced in fast-track patients (3 vs. 6 days, p < 0.001), but emergency readmission rate was higher (16.9 vs. 7.6 %, p = 0.026), although rehospitalization rates were similar (8 vs. 4.2 %, not significant). Independent risk factors of increased length of stay were identified as age >69 years (p = 0.001), laparotomy (p = 0.011), and conventional perioperative care (p < 0.001). CONCLUSIONS: The introduction of a fast-track program reduced postoperative length of stay without increasing complication rate. This study proposes a modulation of the program according to patient age and surgical approach.
Surgical Endoscopy 10/2012; · 4.01 Impact Factor
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ABSTRACT: Bien que le traitement du carcinome épidermoïde de l’anus soit médical (radiochimiothérapie), l’amputation abdominopérinéale
(AAP) reste la seule alternative thérapeutique si la radiothérapie est contre-indiquée ou en cas d’échec du traitement médical.
La chirurgie de rattrapage des carcinomes épidermoïdes de l’anus est une chirurgie mutilante avec sacrifice du sphincter anal
et confection d’une colostomie iliaque définitive. L’exérèse en marge saine, qui constitue le principe fondamental de cette
chirurgie, se traduit par une résection large du périnée dans un terrain irradié. Par conséquent, la chirurgie du carcinome
épidermoïde est grevée d’une morbidité postopératoire élevée en particulier en termes de cicatrisation périnéale. Des techniques
de reconstruction par lambeaux myocutanés ont été développées et ont permis de réduire cette morbidité. Dans un but d’éviction
de la colostomie iliaque définitive, des techniques de colostomie périnéale ont également été décrites. Ces techniques de
reconstruction périnéale ont été utilisées pour les adénocarcinomes du bas rectum avec des résultats satisfaisants sur le
plan oncologique et fonctionnel. Cependant, il existe encore peu de données sur les colostomies périnéales publiées. Leur
faisabilité dans le cadre des carcinomes épidermoïdes de l’anus est limitée par l’étendue de la perte de substance périnéale.
Although the treatment of anal squamous carcinoma is primarily medical, abdomino-perineal resection remains the only alternative
treatment if primary chemoradiotherapy is contraindicated or is unsuccessful. Salvage surgery for anal squamous carcinoma
requires wide excision of the anal sphincter and permanent abdominal colostomy. Such major surgery in an irradiated field
is associated with significant morbidity from delayed wound healingm, but this can be reduced by the use of myocutaneous flaps,
whilst perineal colostomy allows a permanent abdominal stoma to be avoided. These techniques have been employed in the management
of low rectal cancer with good oncological and functional results. However, there is little data on perineal colostomy and
its feasibility in squamous carcinoma is limited by the extent of the perineal surgical resection.
Mots clésCarcinome épidermoïde–Anus–Amputation abdominopérinéale–Colostomie périnéale–Graciloplastie–Lambeau musculocutané–Lambeau de grand droit–Graciloplastie
KeywordsAbdominoperineal resection–Anal canal cancer–Epidermoid carcinoma–Perineal colostomy–Graciloplastie–Musco-cutaneous flap–Rectus abdominis flap
Côlon & Rectum 04/2012; 5(2):72-81.
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Acta gastro-enterologica Belgica 09/2011; 74(3):413-4. · 0.64 Impact Factor
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ABSTRACT: Psychosocial implications of living with FAP remain largely unexplored. This article reviews available literature on three topics: 1) Implications of living with FAP 2) genetic testing and reproductive decision-making and 3) family communication.
Papers published until 2009 about psychosocial and behavioral issues in FAP were identified.
Psychometric data indicate that FAP patients and at-risk relatives as a group do not exhibit clinical symptoms of mental health problems after clinical or genetic diagnosis. However, some subgroups revealed to be more vulnerable to distress. Also, concerns related to the disease and its consequences were reported. While interest in prenatal diagnosis or preimplantation genetic diagnosis seems to be high it is important to study actual uptake because this may reveal to be much lower. Family members are an important source of information and the few available data suggest that family communication is problematic. The findings described have several shortcomings. They were obtained from only a few studies often conducted using specific or mixed study groups, originating from the 90ties and mostly cross-sectional in nature.
For clinical practice, it is important to have more research data on how FAP patients at different ages cope with the disease, on the impact of genetic testing on reproductive decision-making and on family communication. Results reported here need to be confirmed by additional research and new themes need to be explored.
Acta gastro-enterologica Belgica 09/2011; 74(3):438-44. · 0.64 Impact Factor
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ABSTRACT: Restorative coloproctectomy (RCP) with ileal pouch-anal anastomosis (IPAA), is one of the surgical responses to the crucial question of prophylactic treatment in familial adenomatous polyposis (FAP). No consensus has been reached, until now, to choose between IPAA and ileo-rectal anastomosis (IRA), the rectal sparing prophylactic colectomy. This paper aims to review the latest issues related to IPAA and highlights its specificities compared to IRA.
PubMed database was searched using the following search items: familial adenomatous polyposis, surgery, ileal pouch-anal anastomosis, ileo-rectal anastomosis. Papers published between 1978 and 2010 were selected.
Absence of mortality, acceptable morbidity and good functional results combined to high quality of life have promoted the IPAA technique. New technical issues such as the double stapled technique, mesenteric lengthening, omission of temporary protective stoma can be addressed almost systematically for these patients. A laparoscopic approach, lessening the body image impact, has proven to be as effective and safe as the open approach to perform IPAA. Further advantages of laparoscopic IPAA rely on the lower adhesion formation resulting in less small bowel occlusion. Sexuality, fertility and childbirth are important functional issues often cited as threatened by the pelvic manoeuvres of the IPAA technique which can be prevented by close rectal wall dissection and a laparoscopic approach.
IPAA offers the best available prophylaxis in FAP patients. Technical enhancements in IPAA will most probably decrease the functional risks. Thus IPAA remains the alternative to IRA for the prophylactic treatment of FAP.Nevertheless, based on the latest evidence, the choice between both procedures is still matter of debate.
Acta gastro-enterologica Belgica 09/2011; 74(3):427-34. · 0.64 Impact Factor
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S Laurent,
D Franchimont,
J P Coppens,
K Leunen,
L Macken,
M Peeters,
O Plomteux,
M Polus,
B Poppe,
C Sempoux,
S Tejpar,
M Van Den Eynde,
A Van Gossum,
J Vannoote, A Kartheuser,
E Van Cutsem
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ABSTRACT: Colorectal cancer (CRC) is a leading cause of cancer related death in the western countries. It remains an important health problem, often under-diagnosed. The symptoms can appear very late and about 25% of the patients are diagnosed at metastatic stage. Familial adenomatous polyposis (FAP) is an inherited colorectal cancer syndrome, characterized by the early onset of hundred to thousands of adenomatous polyps in the colon and rectum. Left untreated, there is a nearly 100% cumulative risk of progression to CRC by the age of 35-40 years, as well as an increased risk of various other malignancies. CRC can be prevented by the identification of the high risk population and by the timely implementation of rigid screening programs which will lead to special medico-surgical interventions.
Acta gastro-enterologica Belgica 09/2011; 74(3):415-20. · 0.64 Impact Factor
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P Demetter,
W Ceelen,
E Danse,
K Haustermans,
A Jouret-Mourin, A Kartheuser,
S Laurent,
G Mollet,
N Nagy,
P Scalliet,
E Van Cutsem,
M Van Den Eynde,
J Van de Stadt,
E Van Eycken,
J L Van Laethem,
K Vindevoghel,
F Penninckx
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ABSTRACT: Quality of health care is a hot topic, especially with regard to cancer. Although rectal cancer is, in many aspects, a model oncologic entity, there seem to be substantial differences in quality of care between countries, hospitals and physicians. PROCARE, a Belgian multidisciplinary national project to improve outcome in all patients with rectum cancer, identified a set of quality of care indicators covering all aspects of the management of rectal cancer. This set should permit national and international benchmarking, i.e. comparing results from individual hospitals or teams with national and international performances with feedback to participating teams. Such comparison could indicate whether further improvement is possible and/or warranted.
Acta gastro-enterologica Belgica 09/2011; 74(3):445-50. · 0.64 Impact Factor
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Journal of Visceral Surgery 06/2011; 148(3):e225-6. · 0.57 Impact Factor
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ABSTRACT: This study aimed to assess long-term function after total perineal reconstruction (TPR) with dynamic graciloplasty (DG) and systematic Malone appendicostomy (MA) adjunction after abdominoperineal excision (APR) for rectal cancer.
From 1999 to 2004, TPR using DG and MA was performed in 10 patients [seven women; median age 40 (range 28-55) years] after APR for rectal cancer (cT2 in one patient, cT3 in six patients and cT4 in three patients). We prospectively recorded early and late morbidity, mortality, oncological outcome, functional results (using the modified Working Party on Anal Sphincter Replacement 'WPASR' scoring system) and quality of life (QoL; using the European Organisation for Research and Treatment of Cancer 'EORTC' QLQ-C30 and QLQ-CR38 questionnaires).
There was no procedure-related mortality. One patient required intra-abdominal re-operation. Nine patients required local and multiple revisions [there was one coloperineal anastomosis (CPA) stenosis, five CPA mucosal prolapse, three stenosis related to graciloplasty, two MA stenosis and one MA reflux]. After a median follow up of 78 months, there was no local recurrence and six patients were alive and disease-free. Regarding the functional results, the median modified WPASR score, of 8, after a follow up of 78 months, was good. The overall QoL scores remained stable over time.
In carefully selected patients who want to avoid definitive abdominal colostomy after APR for rectal cancer, reconstruction involving MA and DG after APR for low rectal cancer is followed by good long-term function and QoL.
Colorectal Disease 04/2011; 13(4):406-13. · 2.93 Impact Factor
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ABSTRACT: The Malone appendicostomy is a novel option for surgical management of faecal incontinence and chronic constipation, by permitting the administration of antegrade colonic enemas for colonic evacuation. We report the case of a 54-year-old female who had undergone abdomino perineal resection for low rectal cancer followed by total perineal reconstruction with perineal colostomy, dynamic double graciloplasty and Malone appendicostomy. After 7-year follow-up, functional results and quality of life scores were satisfactory. Suddenly the patient described increasing difficulty with intubation of her appendicostomy and complete reflux of the enema liquid, which radiology referred to a calcified body of 35 mm within the Malone appendicostomy causing nearly complete obstruction of the conduit. A surgical exploration was necessary to extract the fecolith allowing full recovery with return to satisfactory Malone appendicostomy function. To our knowledge, this is the first report of a fecolith causing obstruction within a Malone appendicostomy.
Techniques in Coloproctology 02/2011; 15(1):81-3. · 1.29 Impact Factor
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Techniques in Coloproctology 02/2010; 14(1):95-6. · 1.29 Impact Factor
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J-P Machiels,
C Sempoux,
P Scalliet,
J-C Coche,
Y Humblet,
E Van Cutsem,
J Kerger,
J-L Canon,
M Peeters,
S Aydin,
S Laurent, A Kartheuser,
B Coster,
S Roels,
J-F Daisne,
B Honhon,
L Duck,
C Kirkove,
M-A Bonny,
K Haustermans
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ABSTRACT: To assess the safety and preliminary efficacy of concurrent radiotherapy, capecitabine, and cetuximab in the preoperative treatment of patients with rectal cancer.
Forty patients with rectal cancer (T3-T4, and/or N+, endorectal ultrasound) received preoperative radiotherapy (1.8 Gy, 5 days/week for 5 weeks, total dose 45 Gy, three-dimensional conformal technique) in combination with cetuximab [initial dose 400 mg/m(2) intravenous given 1 week before the beginning of radiation followed by 250 mg/m(2)/week for 5 weeks] and capecitabine for the duration of radiotherapy (650 mg/m(2) orally twice daily, first dose level; 825 mg/m(2) twice daily, second dose level).
Four and six patients were treated at the first and second dose level of capecitabine, respectively. No dose-limiting toxicity occurred. Thirty additional patients were treated with capecitabine at 825 mg/m(2) twice daily. The most frequent grade 1/2 side-effects were acneiform rash (87%), diarrhea (65%), and fatigue (57%). Grade 3 diarrhea was found in 15%. Three grade 4 toxic effects were recorded: one myocardial infarction, one pulmonary embolism, and one pulmonary infection with sepsis. Two patients (5%) had a pathological complete response.
Preoperative radiotherapy in combination with capecitabine and cetuximab is feasible with some patients achieving pathological downstaging.
Annals of Oncology 05/2007; 18(4):738-44. · 6.43 Impact Factor
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J-P Machiels,
L Duck,
B Honhon,
B Coster,
J-C Coche,
P Scalliet,
Y Humblet,
S Aydin,
J Kerger,
V Remouchamps,
J-L Canon,
P Van Maele,
L Gilbeau,
S Laurent,
C Kirkove,
M Octave-Prignot,
J-F Baurain, A Kartheuser,
C Sempoux
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ABSTRACT: Preoperative radiotherapy has been shown to decrease the local recurrence rate of patients with locally advanced rectal cancer. Capecitabine and oxaliplatin are both active anticancer agents in the treatment of patients with advanced colorectal cancer and have radiosensitizing properties. Therefore, these drugs would be expected to improve effectiveness of preoperative radiotherapy in terms of local control and prevention of distant metastases.
Forty patients with rectal cancer (T3-T4 and/or N+) received radiotherapy (1.8 Gy, 5 days a week over 5 weeks, total dose 45 Gy, 3D conformational technique) in combination with intravenous oxaliplatin 50 mg/m2 once weekly for 5 weeks and oral capecitabine 825 mg/m2 twice daily on each day of radiation. Surgery was performed 6-8 weeks after completion of radiotherapy. The main end points were safety and efficacy as assessed by the pathological complete response (pCR).
The most frequent grade 3/4 adverse event was diarrhea, occurring in 30% of patients. pCR was found in five (14%) patients. According to Dworak's classification, good regression was found in six (18%) additional patients.
Combination of preoperative radiotherapy with capecitabine and oxaliplatin is feasible for downstaging rectal cancer.
Annals of Oncology 01/2006; 16(12):1898-905. · 6.43 Impact Factor
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ABSTRACT: The authors report a case of a delayed traumatic perforation of the sigmoid colon, presenting three days after a motor vehicle accident. A review of the literature is presented.
Journal de Radiologie 07/2005; 86(6 Pt 1):663-5. · 0.42 Impact Factor
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ABSTRACT: We performed a study to determine if colour Doppler findings may help to identify the cause of wall thickening in acute non-diverticular diseases of the colon. The study group included 66 patients admitted to the emergency department with a final diagnosis of infectious colitis (n=23), inflammatory colitis (n=10), ischaemic colitis (n=23) and malignant tumours (n=10). The following ultrasound features were assessed: maximal wall thickness, wall stratification, arterial flow in the colonic wall and arteriolar resistive index. Higher values of wall thickness were observed in malignant tumour (18.2+/-6.2 mm, p<0.001). Moderately thickened wall (6.6+/-1.3 mm, p< or =0.06), preserved stratification (90% versus 46% in the remainder of the study population) and lower resistive index (0.51+/-0.10, p< or =0.05) were significantly related to inflammatory colitis. Absence of arterial flow was more frequently observed in ischaemia (43% versus 12% in the remainder of the study population). In conclusion, despite some overlap, both ultrasound and colour Doppler features are helpful in the differential diagnosis of colonic thickening related to non-diverticular colonic lesions.
British Journal of Radiology 11/2004; 77(923):917-21. · 1.31 Impact Factor
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ABSTRACT: The aim of this study was to analyze the color Doppler sonographic findings in primary epiploic appendagitis. Color Doppler sonographic findings of ten patients with primary epiploic appendagitis were reviewed. The following sonographic features were analyzed: identification of a mass adjacent to the colonic wall; identification of spotty color areas with arterial flow in this mass and detection of abnormalities of the colonic wall adjacent to the infiltrated fatty tissue. A well-delineated hyperechoic mass adjacent to the colonic wall was detected in each patient with sonography. No colonic wall abnormalities were observed nor color Doppler signal in and around the hyperechoic area. Absence of flow at color Doppler sonography is an additional feature of epiploic appendagitis.
European Radiology 02/2001; 11(2):183-6. · 3.22 Impact Factor
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ABSTRACT: The objective of this study was to compare the value of color Doppler sonography with early clinical and laboratory findings in determining the prognosis of patients with ischemic colitis.
We reviewed the early clinical, laboratory, and color Doppler sonographic data of 24 patients with ischemic colitis. The patients were divided into two groups on the basis of their outcome. The first group comprised the patients with transient ischemia who recovered uneventfully, and the second group included the patients who needed surgery because of symptomatic transmural colic gangrene or colic stricture. Clinical data and laboratory values were compared with color Doppler sonographic findings including colic wall thickness, presence of stratification, and arterial flow in the bowel wall.
At univariate analysis, increased age (p = 0.007), leukocyte count (p = 0.030), lactate dehydrogenase level (p = 0.030), blood lactate level (p = 0.041), and absence of vascular flow in the colic wall (p<0.001) were significantly related to complicated ischemic colitis. At multivariate analysis, absence of arterial flow was the only significant predictor of complicated ischemic colitis (p = 0.002), with a sensitivity of 82%, a specificity of 92%, a positive predictive value of 90%, and a negative predictive value of 86%.
Absence of arterial flow in the wall of the ischemic colon on initial color Doppler sonography is suggestive of an unfavorable outcome and is more closely associated with outcome than early clinical and laboratory findings.
American Journal of Roentgenology 10/2000; 175(4):1151-4. · 2.78 Impact Factor
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ABSTRACT: The Apc1638N mouse model, which carries a targeted mutant allele within the adenomatous polyposis (Apc) gene and develops intestinal tumours spontaneously, predominantly in the small bowel, was used to investigate the effects of two potential chemopreventive agents, aspirin and alpha-amylase resistant starch (RS). Heterozygous Apc+/Apc1638N mice were fed semi-purified diets rich in animal fat, animal proteins and sucrose and low in dietary fibre (Western style diets) from approximately 6 weeks up to 6 months of age. Two of the diets contained aspirin (300 mg/kg diet) and two RS (1:1 mixture of raw potato starch: Hylon VII at 200 g/kg diet) in a 2 x 2 factorial design. A fifth treatment group were fed a conventional rodent chow diet. The mice fed the Western style diets became almost three times as fat as the chow-fed mice but this did not affect tumour yield. Treatment with RS resulted in significantly more intestinal tumours whereas aspirin alone had no effect. However, there was a significant aspirin x RS interaction, which suggests that aspirin could prevent the small intestine tumour-enhancing effects of RS in this Apc-driven tumorigenesis model. The possibility that large amounts of purified forms of resistant starch may have adverse effects within the small bowel is a novel observation that requires further investigation since greater intakes of starchy foods (and of RS) are being encouraged as a public health measure in compensation for reduced dietary fat intake. However, it remains possible that any increased risk is restricted to carriers of germline mutations in APC.
Carcinogenesis 06/1999; 20(5):805-10. · 5.70 Impact Factor
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ABSTRACT: Subacute ischaemic proctitis is a rare condition. We describe the case of a 60-year-old male patient who developed, after aortic aneurysm repair, a transient ischaemic colitis that totally healed without sequelae. He eventually developed symptoms of severe proctitis. Investigations identified a stenosis of the mid rectum, while the upper rectum was inflammatory. On angiogram, there was a poor blood flow through the Riolan's arcade and a stenosis of the proximal aorto-graft anastomosis. Diagnosis of subacute ischaemic proctitis due to poor blood supply through the internal iliac arteries was made. Anti-inflammatory drugs and dilations were inefficient. A subtotal proctectomy with low colorectal anastomosis was required. On pathological specimen, the lesions were strongly suggestive of an ischaemic process. The patient had an excellent recovery and was asymptomatic 8 months after the operation.
Acta chirurgica Belgica 03/1999; 99(1):36-8. · 0.43 Impact Factor
